Four years ago, my colleagues Drs. Annie LaVigne and Sara Alcorn came to me with a question.

We had been speaking with my lab group about disparities in access to, and receipt of, cancer care — a particularly difficult topic in a field with as much expense and equipment as radiation oncology. Studies consistently show varying availability of radiotherapy resources between rural and urban environments, posing a formidable barrier to many patients who seek oncologic treatment.

Yet Drs. LaVigne and Alcorn made an acute observation: A confounding number of eligible patients in East Baltimore also do not receive the radiotherapy they need — despite living minutes away from a hospital as well-resourced as Johns Hopkins. Why?

This conversation jump-started a fascinating study that the two physician-scientists published last year in the International Journal of Radiation Oncology, together with physician colleagues from the Johns Hopkins Kimmel Cancer Center: Jean Wright, Curtiland Deville Jr. and Srinivasan Yegnasubramanian.

Their central finding: “Proximity to care does not equal access,” notes Dr. Lavigne. Instead, access to radiotherapy rests upon a range of factors: from the cost and availability of transportation to racial and socioeconomic demographics.

Drs. LaVigne and Alcorn found that radiotherapy “deserts” are most common in rural counties, low-income areas and neighborhoods with particularly high populations of Black Americans.

“Drawing inspiration from epidemiologic work investigating ‘food deserts,’ we asked, ‘Can we map radiotherapy deserts?’” explains Dr. LaVigne, an instructor in radiation oncology at Johns Hopkins Medicine. “How would we define and locate those? How would we approach them not only geospatially, but also with consideration of socioeconomic factors?” 

“The issue isn’t just the availability of resources,” says Dr. Alcorn, now vice chair of clinical strategy at the University of Minnesota. “It’s also the level of oncologic need: What are the prevalence and death rates of specific cancers in that area? And how does that relate to provider availability? From that perspective, the matching of need with resources is what we thought was lacking.”

So, the researchers developed a tool — an open-access web platform — which they shared in their article, “Radiotherapy Deserts: The Impact of Race, Poverty, and the Rural-Urban Continuum on Density of Providers and the Use of Radiation Therapy in the U.S.”

This database shows the incidence and mortality rates of prostate and breast cancer across the U.S. at a county level, overlaid with radiation oncology physician and utilization density, in addition to sociodemographic data. In defining and locating radiotherapy deserts, this platform is the most advanced model of its kind.

“To date, a significant portion of work and discussion in the health equity space has been observational,” says Dr. LaVigne. “We have lacked the translational component. That’s what we hope to support through our work. We want to provide the infrastructure needed to drive targeted interventions.”

She and Dr. Alcorn hope their model will help policymakers, providers, social workers and community organizers better understand their local radiation oncology needs.

It was a privilege to support their work on this pathbreaking project, and I couldn’t be more excited by the outcome. It adds to the growing body of important research unfolding across Johns Hopkins Medicine by our physician-scientists who are dedicated to dismantling long-entrenched disparities in health care to achieve our shared vision: health equity for all.

As for next steps? Drs. LaVigne and Alcorn are designing provider-, patient- and caregiver-facing focus groups to conduct further needs assessments, which will help identify unique and shared barriers to care across radiotherapy deserts.

“It’s not as simple as relocating machines and providers to rural areas,” says Dr. LaVigne. “This problem, unfortunately, has no one-size-fits-all solution: Interventions will have to account for the heterogeneity our work has found. But if it’s used well, our platform could inspire approaches that better serve providers, communities and, most importantly, patients.”